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So Far, Healthy Families Transition Going Smoothly

Thursday, January 24, 2013

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So Far, Healthy Families Transition Going Smoothly

by David Gorn, California Healthline Sacramento BureauThursday, January 24, 2013

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Given the immense amount of worry and concern over the planned shift of 860,000 kids out of the Healthy Families program and into Medi-Cal managed care plans, there has been surprisingly little turmoil throughout the start of the first phase of that transition.

"Phase 1 has gone extremely smoothly," said Jane Ogle, deputy director for the Department of Health Care Services. "It's going the way we thought it might. We're really just moving from one payer source to another. So it's gone very, very quietly."

The transition started Jan. 1, moving 197,000 children to Medi-Cal managed care plans. So far, according to DHCS officials, the telephone complaint hotline has been pretty quiet.

The call center at the Managed Risk Medical Insurance Board, which ran Healthy Families, has been busy. MRMIB officials report more than 36,000 calls in December 2012 and about 7,000 calls during the first week of January.

Most calls were in response to notices about the Healthy Families transition mailed over the past few months. Ogle pointed out that there was no spike in calls so far in January compared to calls in December.

"We haven't seen any uptick in call volume at all," Ogle said, adding that she hasn't yet heard any complaints about access. "We call all of our health plans daily," she said, "and we haven't heard anything. It's just not there. We would hear it or DMHC (Department of Managed Health Care) would hear it, and ... nothing."

Children's health advocates say it's a little early to make any judgments but they hope the relatively quiet transition so far means there are relatively few problems.

"That's what we're trying to assess right now," said Kristen Golden Testa, director of the California Health Program for The Children's Partnership. She said several provider groups are conducting surveys of their members to see what providers are experiencing, and that data hasn't come in yet. "I'm not sure I would rely on the call center and complaint lines because on the ground is where we'll hear it," she said.

Ogle and advocates agree that the first phase is the easier part.

Smooth Till Summer?

In the first phase, Ogle said, children "didn't change physicians, and these are basically healthy children. So there aren't the coordination-of-care issues here."

The second phase launches April 1, with another 273,000 children making the switch. Ogle thinks that transition will be similar to the first phase, with a relatively low level of controversy or challenge. The third and fourth phases, beginning in August, will be the bigger challenge, she said, even though they have a combined total of about 191,000 children, which is smaller than either of the first two phases.

"The first phase will go smoothly, and the second one, which is primarily Kaiser children, should go smoothly, too," Ogle said. "When we get into Phase 3, that's where some people might have to pick a new primary care provider."

Serena Kirk, a senior policy associate at Children's Defense Fund, said there will be two real tests of the transition: What happens in August, when Phase 3 begins, and what happens to children when they first start seeking medical care under the new program.

"We don't have a complete sense yet [of the transition], but it has seemed good so far," Kirk said. "While we haven't seen any red flags in the past few weeks, we also haven't been anticipating problems for this phase. So we remain somewhat concerned."

Kirk said it's unlikely that any problems with access will crop up until those kids visit the doctor.

"We won't have a true sense of how they access care until they need care, and then we'll get a better sense," she said.

One big marker of transition effectiveness will come next month with the state's first monthly report to CMS, Golden Testa said. She hopes provider and advocacy groups will have their own survey information by then.

"We'll hopefully get some responses around the surveys," she said. "We don't want to wait for the monthly report in mid-February."

Health Net Not Ready

Before the state launched the transition Jan. 1, the Department of Managed Health Care conducted a network adequacy assessment. One of the insurers, Health Net of California, said it would not be ready by Jan. 1 so DHCS officials allowed Health Net to delay moving its Healthy Families children.

Children's Defense Fund's Kirk said that was a good sign.

"First and foremost, if the network isn't ready, whatever needed to be done should be done," Kirk said. "That's the responsible way to do that."

In planning seminars and stakeholder input sessions before the transition, questions about what would happen if a health plan wasn't ready for the transition came up often. Kirk said health officials often wouldn't directly answer that question.

"So we were a little wary from that," Kirk said. "The fact that they did the right thing, the responsible thing, that's good, and it's how we hope the transition will continue. The bottom line is the outcomes for these kids, so having them wait was the right thing to do."

An issue brief released last week by the Palo Alto-based Lucile Packard Foundation for Children's Health urged state officials to take proactive measures to avoid children losing access to care in the shift to Medi-Cal.

"We certainly heard [advocates'] concerns early on, and we structured the transition to take all of those concerns into account," Ogle said. "I think the fact that we listened carefully has helped. This was all done and designed to address the concerns of the advocates."

If DHCS officials are correct, and the first seven months of the transition go smoothly, Kirk said she hopes it will give officials the breathing room to make a more specific contingency plan for the start of the more-difficult Phase 3 in August.

Golden Testa said she'd like nothing better than the state to be 100% right about its ability to smoothly move 860,000 children out of Healthy Families and into Medi-Cal.

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My son was healthy families. I called in Sept. because of concerns with his special health conditions and the recent merge with medical/healthy families. My son had a surgery to place a bar in his chest for a chest deformity and suffered major complications from the surgery. He had spent 20 days in the hospital. So I called in advance to make sure my son would be able to see his cardiologist only to be assured that we would receive information in the mail but everything will be fine. We NEVER received ANYTHING! Now not only did the insurance change but we are unable to see our regular pediatrician along with the cardiologist. The cardiologist requested a new plan for us only to get denied leaving our son with a bar placed in our chest and to expect us to find a new surgeon to remove it that had no history with our child's medical condition or medical history. This NEW medical situation has been a nightmare for our family and we feel it has place our child at risk.

November 17, 2013 at 6:47 PM

sue adels

This is a nightmare for the families .I am a family and my yearly recertification was sent to healthy families in July was due end of August.They are supposed to be sending to Medi Cal and it is October and Medi Cal is still not showing us enrolled. I did talk to them mid September and they said they were missing things not forwarded from Healthy families. Sent missing items direct to Medi cal they said they then had it still waiting on approval.I have to spend hours trying to get through to speak to a person at Medi Cal. Meanwhile my 2 children currently show no insurance. Had Healthy families foe 12 years never a problem.
Not to mention one child with ADHD had been seeing a therapist for 2 years now no longer covered and can't find a decent therapist that is interested in taking Medi Cal. This has been devastating for my child as she now is without help.

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